Healthcare Provider Details

I. General information

NPI: 1275094013
Provider Name (Legal Business Name): CARRIE LAN VUONG SIOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE LAN VUONG MD

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8899 UNIVERSITY CENTER LN STE 350
SAN DIEGO CA
92122-1010
US

IV. Provider business mailing address

8899 UNIVERSITY CENTER LN STE 350
SAN DIEGO CA
92122-1010
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8322
  • Fax: 858-657-1610
Mailing address:
  • Phone: 858-657-1675
  • Fax: 858-657-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA181265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: